Long-term evolution of chronic daily headache with medication overuse in the general population

To investigate long-term efficiency of an intervention protocol for chronic daily headache with medication overuse (CDHwMO) in the general population.

The 72 subjects meeting CDHwMO criteria coming from an epidemiological study in the general population (Neurology 2004; 62: 1338-42) were offered follow-up and treatment for 1 year and then discharged to their general practitioner with treatment recommendations. Four years later, they were interviewed again. They filled in a diary for 1 month and the SF-12 test.

After 1 year, 46 (64%) did not fulfill MO criteria while 26 (36%) did. After 4 years, 68 subjects were contacted. Of those, 38 (58%) did not have CDHwMO, while 30 (44%) still had MO. Among those 38 subjects without MO criteria, 6 still met CDH criteria. Remission at year 1 was a significant predictor for sustained remission at year 4. Age, gender, civil status, socioeconomic situation, and CDH type were not different in the group with MO vs those without MO. Consumption of nonsteroidal anti-inflammatory drugs and/or triptans was significantly higher in subjects without CDH and MO, while the use of ergotics and/or opioids was significantly higher in those patients who still met CDHwMO criteria. Quality of life (QoL) was significantly better at 4 years for the whole group.

After 4 years, almost 60% of subjects did not fulfill CDHwMO criteria and their QoL was also improved. This justifies public health interventions that should include recommendations on a judicious use of symptomatic medications together with an early use of preventatives.